Healthcare Provider Details

I. General information

NPI: 1801991963
Provider Name (Legal Business Name): TICHENOR LOWMAN MILLER MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 TERMINO AVE SUITE 308
LONG BEACH CA
90804-2105
US

IV. Provider business mailing address

PO BOX 1354
LONG BEACH CA
90801-1354
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-0249
  • Fax: 562-933-3747
Mailing address:
  • Phone: 562-933-0249
  • Fax: 562-933-3747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberA70356
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA70356
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberA70356
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA70356
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberA70356
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberA70356
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberA70356
License Number StateCA

VIII. Authorized Official

Name: DR. TORIN CUNNINGHAM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-933-0249